Professional Documents
Culture Documents
Not at All A Little Bit Some-What Quite A Bit Very Much 0 1 2 3 4 Please Indicate How True Each Statement Has Been (Over The Past Four Weeks)
Not at All A Little Bit Some-What Quite A Bit Very Much 0 1 2 3 4 Please Indicate How True Each Statement Has Been (Over The Past Four Weeks)
0 1 2 3 4
1. I am frustrated by my conditiom
2. I have trouble using my eyes
3. I have trouble eating
4. I have limited my social activity
because of my condition
5. My condition limits my ability to
enjoy hobbies and fun activities
6. I have trouble meeting the
needs of my family
7. I have to make plans around my
condition
8. My occupational skills and job
status have been negatively
affected
9. I have difficulty speaking
10. I have trouble driving
11. I am depressed about my
condition
12. I have trouble walking
13. I have trouble getting around
public places
14. I feel overwhelmed by my
condition
15. I have trouble performing my
ersonal grooming needs